Background: Patients with low back pain (LBP) frequently present to emergency departments (ED) in Australia. There is however little evidence on the drivers for prolonged ED length of stay (LOS) and re-presentations in this population.
Aims: To describe ED re-presentation rates and LOS of patients presenting with LBP, and to explore potential factors associated with these outcomes.
Methodology: This retrospective medical record review study extracted routinely collected data from three Sydney Local Health District EDs from 2016 to 2021. We extracted data for all patients aged 18+ years who presented to ED with a discharge diagnosis of non-specific LBP or lumbar radiculopathy. Patient characteristics were used to determine associated factors (e.g. age, gender, socioeconomic status, ethnicity, use of opioids, imaging referral) with re-presentations within 12 months and prolonged LOS (>4 hours).
Results: Of 8,289 episodes of non-serious LBP, 7.7% had at least one ED re-presentation within 12 months. There were only 14 ED re-presentations (0.2%) where the diagnosis changed from non-serious LBP at the index ED visit to serious spinal pathology at the repeat visit. The mean ED LOS was 4.1 hours, and 26.9% of patients stayed in the ED >4 hours. Older patients (aOR: 1.49; 95% CI: 1.26–1.77) and those who received opioids (aOR: 1.34; 95% CI: 1.10–1.62) were more likely to re-present. In contrast, patients receiving imaging were less likely to re-present (aOR: 0.79, 95% CI: 0.66–0.94). Receiving imaging (aOR: 2.63; 95% CI: 2.39–2.90) and opioids (aOR: 1.70; 95% CI: 1.53–1.88) increased the odds of a prolonged stay.
Conclusion and Implications: A re-presentation within 12 months occurs in 7.7% of episodes of LBP in ED. Over one-quarter of patients stayed longer than 4 hours. Future trials should test interventions to improve ED patient flow and strategies to reduce re-presentations.